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High risk of adverse pregnancy outcomes in women with a persistent lupus anticoagulant

Johanna Gebhart, Florian Posch, Silvia Koder, Peter Quehenberger, Thomas Perkmann, Lorenz Kuessel, Cihan Ay and Ingrid Pabinger

Data supplements

Article Figures & Data

Tables

  • Table 1.

    Distribution of prepregnancy clinical and laboratory variables according to pregnancy complication status (n = 40 pregnancies)

    VariableNo pregnancy complication (n = 12 pregnancies, N = 6 women)Pregnancy complication (n = 28 pregnancies, N = 17 women)P*
    Demographic and clinical variables
     Age at pregnancy onset (range), y33 (31-37)31 (28-35).055
     Prior history of venous thrombosis10 (83)21 (75).563
     Number of women with a prior history of venous thrombosis5 (83)12 (71).541
     Number of women with a prior history of arterial thrombosis0 (0)0 (0)N/A
     Prior history of pregnancy complications6 (50)17 (61).530
     Number of women with a prior history of pregnancy complications4 (67)9 (53).560
     Autoimmune rheumatic disease4 (33)6 (21).435
     LDA alone0 (0)2 (7).485
     LMWH alone0 (0)5 (18).298
     LDA+LMWH10 (83)18 (64).285
    Laboratory variables
     Rosner index34 (26-42)36 (33-47).043
     aPTT-LA, s81 (75-100)96 (82-113).056
     aCL IgM6.2 (1.9-23.0)5.3 (2.9-9.8).243
     aCL IgG, GPL25.8 (15.0-106.1)51.8 (26.3-120.0).198
     aβ2GPI IgM§5.0 (2.3-44.1)2.9 (1.4-8.5).229
     aβ2GPI IgG, GPL§41.0 (11.4-97.1)44.8 (10.1-100.0).788
     Triple antibody positivity§4 (36)17 (61).182
    • Data represent either a median (25th-75th) for continuous variables or an absolute frequency (%) for count data. Data are reported for individual pregnancies, except for “Number of women with a prior history of thrombosis” and “Number of women with a prior history of pregnancy complications,” which report data for individual women.

    • N/A, not applicable.

    • * P value for a difference between pregnancies with and without complications from a linear or generalized linear regression model taking into account the dependent data structure (ie, that women could have >1 pregnancy).

    • Pregnancy complications were defined according to revised Sapporo criteria.1

    • Autoimmune rheumatic disease was defined as 4 cases of systemic lupus erythematosus and 1 case of lupus-like disease.

    • § aß2GPI IgG/IgM antibodies missing in 1 pregnancy. Cutoffs for triple antibody positivity were defined as follows: aCL >40 GPL/MPL U/mL; aβ2GPI IgG >8 GPL/MPL U/mL.

  • Table 2.

    Univariable logistic regression models of pregnancy complication risk (n = 40 pregnancies)

    VariableOR95% CI
    Demographic and clinical variables
    Mean age (per 5-y increase)0.410.19-0.87
    Prior history of thrombosis0.600.10-3.50
    Prior history of pregnancy complications*1.550.39-6.14
    Autoimmune rheumatic disease0.550.12-2.5
    LDA aloneN/EN/E
    LMWH (any dose level) aloneN/EN/E
    LDA+LMWH0.360.06-2.02
    Laboratory variables
    Rosner index (per doubling)4.511.08-18.93
    aPTT-LA (per doubling)5.210.80-33.87
    aCL IgM (per doubling)0.930.55-1.57
    aCL IgG (per doubling)1.420.90-2.23
    aß2GPI IgM (per doubling)§0.740.49-1.12
    aß2GPI IgG (per doubling) §1.080.74-1.57
    Triple antibody positivity§2.700.63-11.68
    • CIs were adjusted for the dependent data structure (ie, that women could have >1 pregnancy).

    • N/E, not evaluated.

    • * Pregnancy complications were defined according to revised Sapporo criteria.1

    • Autoimmune rheumatic disease was defined as 4 cases of systemic lupus erythematosus and 1 case of lupus-like disease.

    • Laboratory variables were log2-transformed to stabilize skewed distributions. Corresponding ORs represent the relative increase in the odds of a pregnancy complication per doubling of the respective laboratory parameter.

    • § aß2GPI IgG/IgM antibodies missing in 1 pregnancy. Cutoffs for triple antibody positivity were defined as follows: aCL >40 GPL/MPL U/mL, aβ2GPI IgG >8 GPL/MPL U/mL.

  • Table 3.

    Pregnancy outcomes according to anticoagulant treatment during pregnancy

    No anticoagulation (n = 5)LMWH alone (n = 5)LDA alone (n = 2)LMWH+LDA (n = 28)
    Abortion <10 WOG2226
    Late abortion 10-24 WOG1207
    Birth <34 WOG0105
    Birth ≥34 WOG20010
    Live birth rate2/51/50/215/28
  • Table 4.

    Number of pregnancies in each LMWH dose category according to pregnancy outcomes during the observation period and the individual index APS presentation at study inclusion

    No LMWHLMWH prophylactic dose*LMWH half-therapeutic doseLMWH therapeutic dose
    Pregnancy complication54712
     Early abortion <10th WOG4215
     Late abortion 10th to 24th WOG1135
     Delivery <34th WOG0132
    Uncomplicated pregnancy2145
    Thrombotic APS2254
    Obstetric APS1112
    Thrombotic/obstetric APS02511
    LA positivity only4000
    • * Enoxaparin-natrium 40 mg or dalteparin-natrium 5000 IU once daily, not adjusted to body weight.

    • Enoxaparin-natrium 40 mg or dalteparin-natrium 5000 IU twice daily or adjusted to body weight (1 mg/kg body weight once daily for enoxaparin-natrium or equivalent).

    • Adjusted to body weight (1 mg/kg body weight twice daily or 1.5 mg/kg once daily for enoxaparin-natrium or equivalent).